City
State Zip
Phone ()
Fax ( )

E-mail

Is the applicant’s hometown in a rural, urban or suburban area?
Rural Urban Suburban
This information is being requested in honor of the scholarship’s benefactor.

Name of University/College
Department and Program Area
Degree sought
University Address:
City
State Zip
Faculty Advisor
Title

NOMINATION CHECKLIST

• Nomination Form.
• An official (sealed) transcript (including course titles) and a copy of the program of study requirements’ for health education degree.
• A letter of recommendation from an academic advisor on official institution letterhead verifying: a) the nominees commitment to the pursuit of a degree in health education; b) the number of credits required toward a major in health education; c) the number of credits the student nominee has completed towards their health education degree.
• Written statement (not more than two pages, double-spaced, at least 10 pt. Font) addressing issues impacting the future of health education and the nominee’s perceived roles or desires for contributing to the resolution of these issues.
• Resume
• Demonstrated financial need as verified by the completion of the SOPHE Vivian Drenckhahn Student Scholarship Demonstrated Financial Need Form.